Friday, April 15, 2011


Mr Albers came in bleeding.  He’d been on the toilet, gushing blood, getting light-headed.  Mrs Albers dialed 911.  The momentum of that panic carried Mr Albers all the way to the operating room.  He was 92, and I should have put my foot down.

Imagine you could choose how you die.  In your sleep?  Old age?  Natural causes?  Here’s a secret:  Natural causes are the usual causes in the elderly:  heart attacks, strokes, fatal heart rhythms, ruptured aneurysms.  I dread awakening in the night half paralyzed, short of breath, or with crushing chest pain as my wife deeply sleeps.  Much less do I want to awaken alone, dying.  I would feel a tremendous compulsion to say goodbye. 

Bleeding to death allows goodbyes.

Mr Albers chose surgery over bleeding to death.  Better said, he couldn’t conceive he had a choice.  Watching your blood flow from you unchecked, forming warm purple pudding clots all around?  You’re a man before a firing squad, ready and aiming.  Ambulance sirens, frantic families, and emergency protocols beget consultations and treatment, not ruminations on peaceful passing.

I gave the Albers family my grim prediction and ten minutes alone together before wheeling to the OR – and on to his life of being cared for.  Ventilator.  Sedation.  Infection.  Mr Albers operation had been successful – we’d stopped the hemorrhage.  I’d also robbed the Albers family of a short and dignified goodbye.  Instead, they got many weeks of crushed hopes - the long goodbye.

If I bleed at 92, my care plan is:  Just enough transfusions to share favorite stories and say goodbyes in a calm room full of family, morphine at the ready for shortness of breath, and Bach's Air on the G String.  (Plan subject to change.)

(This post also appears in KevinMD)

1 comment:

  1. Truly appreciate your perspective and insight on end of life. Wish all surgeons shared your sentiments.
    Stephanie Skogen, RN, APN Palliative Care
    La Crosse, WI